Dropout incidence due to side effects is about 20%. Side effects with unknown frequency include (but are not limited to): Digestive effects: Constipation Diarrhoea Dry mouth Nausea Taste disturbances Vomiting Effects on the heart: Arrhythmia ECG changes Abnormal heart rhythm Heart block Sudden cardiac death High heart rate Blood abnormalities: Abnormal blood cell counts Blood sugar changes Low blood sodium levels Breast effects: Breast enlargement, including in males. Spontaneous breast milk secretion that is unrelated to breastfeeding or pregnancy Effects on the skin: Abnormal sweating Hair loss Hives Increased light sensitivity Itching Rash Mental / neurologic effects: Delusions Hallucinations Headache Hypomania/mania Seizures Suicidal behaviour Other effects: Appetite changes Blurred vision Difficulty emptying the bladder Difficulty talking due to difficulties in moving the required muscles Liver problems Ringing in the ears Sexual dysfunction, such as impotence Swelling Weight changes Withdrawal If abruptly stopped after regular use it can cause withdrawal effects such as sleeplessness, irritability and excessive sweating. Overdose Compared to other TCAs, lofepramine is considered to be less toxic in overdose. Its treatment is mostly a matter of trying to reduce absorption of the drug, if possible, using gastric lavage and monitoring for adverse effects on the heart. Interactions Lofepramine is known to interact with: Alcohol. Increased sedative effect. Altretamine. Risk of severe drop in blood pressure upon standing. Analgesics (painkillers). Increased risk of ventricular arrhythmias. Anticoagulants (blood thinners). Lofepramine may inhibit the metabolism of certain anticoagulants leading to a potentially increased risk of bleeding. Anticonvulsants. Possibly reduce the anticonvulsant effect of antiepileptics by lowering the seizure threshold. Antihistamines. Possible increase of antimuscarinic (potentially increasing risk of paralytic ileus, among other effects) and sedative effects. Antimuscarinics. Possible increase of antimuscarinic side-effects. Anxiolytics and hypnotics. Increased sedative effect. Apraclonidine. Avoidance advised by manufacturer of apraclonidine. Brimonidine. Avoidance advised by manufacturer of brimonidine. Clonidine. Lofepramine may reduce the antihypertensive effects of clonidine. Diazoxide. Enhanced hypotensive (blood pressure-lowering) effect. Digoxin. May increase risk of irregular heart rate. Disulfiram. May require a reduction of lofepramine dose. Diuretics. Increased risk of reduced blood pressure on standing. Cimetidine, diltiazem, verapamil. May increase concentration of lofepramine in the blood plasma. Hydralazine. Enhanced hypotensive effect. Monoamine oxidase inhibitors (MAOIs). Advised not to be started until at least 2 weeks after stopping MAOIs. MAOIs are advised not to be started until at least 1–2 weeks after stopping TCAs like lofepramine. Moclobemide. Moclobemide is advised not to be started until